Sobre la obesidad, en la medicina greco-romana / On obesity, in Greco-Roman medicine

Ya en la Grecia antigua se creyó que la obesidad era una enfermedad. Tan solo un cuerpo en equilibrio era sano, según Pitágoras, de Crotona. En el siglo VI a.C. Alcmaeon, también de Crotona, fue el primero que pensó en nutrición. Un cuerpo bien equilibrado está sano, idea desarrollada en Corpus Hippocraticum, atribuido a Hipócrates, médico griego y en Régimen y Aforismos dice que un régimen nutricional equilibrado es esencial para la salud; su desequilibrio puede causar enfermedad. Otra teoría sobre obesidad fue desarrollada posteriormente por Galena de Pérgamo, en Roma; concibió la nutrición como manifestación de la "facultad nutritiva" del cuerpo y en la obesidad prescribía ejercicio muscular con terapia física y dietética. Thessalus de Tralles aplicaba un tratamiento (metasincrisis). Su objetivo era que, cuando fallaban los habituales remedios, se debía cambiar la composición del organismo (sincrisis). Sorano de Éfeso, nació en Asia Menor, pero practicó en Roma. Para este médico "Adiposidad... una forma e caquexia con síntomas de peligro". Empleó un sistema sofisticado de tratamiento de obesidad combinando métodos dietéticos y físicos con terapia conductual. Durante siglos, formas moderadas de obesidad fueron consideradas signos de buena salud y las más graves, desviaciones normales. En la segunda mitad del siglo XIX la obesidad fue "descubierta de nuevo" como exceso de la ingesta sobre el gasto (AU)

Already in the ancient Greece one believed that the obesity was a disease. Only a body in balance was a disease. Only a body in balance was healthy, according to Pitágoras, of Cronona. In VIth century B. C. Alcmaeon, also of Crotona, was the first one who thought about nutrition. A balance well body is healthy, idea developed in Corpus Hippocraticum, attributed to Hipócrates, medical Greek and in Regimen and Aphorisms he says that a nutritional balanced regimen is essential for the health; his imbalance can cause disease. Another theory on obesity was developed later by Galeno of Pergamon, in Rome; he conceived the nutrition as manifestation of the "nourishing faculty" of the body and in the obesity he was prescribing muscular exercise with physical and dietetic therapy. Tralles's Thessalus was applying a treatment (metasincrisis). His aim was, that in when they were trumping the habitual remedies, had to change the composition of the organism (sincrisis). Efeso's Sorano, was born in Asia Minor, but he practiced in Rome. For this doctor: "Adiposity... a form of caquexia with symptoms of danger". It used a sophisticated system of treatment of obesity combining dietetic and physical methods with behavioral therapy. For centuries, moderate forms of obesity were considered to be signs of good health and the most serious, standard deviations. In the second half of the XIXth century the obesity was "discovered again" as excess of the ingestion on the expense (AU)

Franz boas y sus estudios sobre antropología física (en recuerdo a los 150 años de su nacimiento) / Franz Boas and his studies on physical anthropology

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Leonardo da Vinci y sus estudios sobre los segmentos corporales / No disponible

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Proporcionalidad de los segmentos corporales en el niño, según los pintores Alberto Durero y Francisco Pacheco / Proportionality of body segments in the child, according to the artists Alberto Durero and Francisco Pacheco

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Estado nutricional de los niños inmigrantes / Nutritional condition of immigrant children

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Interés de la cuantificación del gasto energético en pediatría. Métodos de laboratorio y de campo / Utility of the quantification of energy expenditure in pediatrics: laboratory and field methods

El gasto y la ingestión energéticos son los dos actores modificables que intervienen en el balance energético de un individuo. Los métodos que se utilizan actualmente para la cuantificación de los componentes del gasto energético (calorimetría directa e indirecta, monitorización del ritmo cardiaco minuto a minuto, agua doblemente marcada, acelerometría y cuestionarios de actividad física), permiten la evaluación de las necesidades calóricas existentes en cualquier alteración nutricional caracterizada por balances energéticos positivos (obesidad) o negativos (sida, fibrosis quística, etc.). Además de su utilidad en la práctica clínica diaria, algunos de estos métodos son empleados en grupos de niños y adolescentes, en condiciones libres, para el estudio de los hábitos de actividad física y de la energía gastada en su realización (AU)

Nuevos métodos para la evaluación del estado nutricional del niño y adolescente / New methods for the assessment of nutritional status

Actualmente existen numerosos métodos para la evaluación del estado nutricional y la composición corporal del niño y del adolescente. Se pueden clasificar en métodos `de referencia' y métodos `de campo'. Los primeros suelen ser precisos y exactos, aunque también caros y difíciles de adaptar a la práctica clínica. Los segundos son fáciles de realizar, portátiles y cómodos para utilizar en la cabecera de la cama del enfermo, pero no consiguen la exactitud de los anteriores. La aparición de ciertos métodos como la pletismografía por desplazamiento de aire, la absorciometría dual por rayos-X, la espectroscopía de infrarrojos o las nuevas técnicas de Impedanca bioeléctrica han permitido, mediante estudios piloto, explorar las posibilidades de ciertos métodos de referencia utilizándolos como métodos de campo, obteniendo datos más precisos en muestras numerosas de individuos (AU)

[Effect of apolipoprotein E phenotypes on the response to dietary treatment of children with hypercholesterolemia]. / Efecto de los fenotipos de la apolipoproteína E en la respuesta al tratamiento dietético en niños con hipercolesterolemia.

OBJECTIVE: Our objective was to determine if apo E phenotypes have any effect on the serum lipoprotein response to dietary intervention in children with hypercholesterolemia. PATIENTS AND METHODS: We have selected 76 children with total serum cholesterol levels higher than 200 mg/dL. At diagnosis, each patient met with a member of our clinic that established dietary recommendations (total and saturated fat intake: 30 and 10%, respectively, of total energy intake). At diagnosis and after 6 months of therapy we determined a lipoprotein profile. RESULTS: After 6 months of therapy, there was only a significant change in children with phenotype E3/E4, with significant decreases in serum total cholesterol (from 247 +/- 43 to 231 +/- 47 mg/dL, p = 0.002), LDL-cholesterol (from 164 +/- 47 to 149 +/- 48 mg/dL, p = 0.002) and triglycerides (from 81 +/- 36 to 71 +/- 31 mg/dL, p = 0.028) concentrations. Absolute and % delta differences in serum lipoprotein concentrations before and after dietary treatment do not show significant differences between apo E phenotype groups. CONCLUSIONS: In the group studied, apo E phenotypes do not determine the response to a low-fat, low-cholesterol diet in children with hypercholesterolemia. To know the factors that determine the variability in the response to dietary intervention in children with hypercholesterolemia it would be interesting to study other familial and genetic factors.

[Body fat mass in boys and male adolescents]. / Masa grasa corporal en niños y adolescentes de sexo masculino.

OBJECTIVE: To describe the proportion of body fat mass, quantified from the measurement of 4 skinfold thickness, in a sample of male children of Zaragoza. METHODS: In 1995, we have studied 701 males aged 6.0 to 14.9 years, from 6 schools of the province of Zaragoza. We have measured: weight, height, and biceps, triceps, subscapular and suprailiac skinfold thicknesses. Body density has been calculated from the 4 skinfold measurements, with the formulas of Sarría et al. Fat mass (%), was calculated with the Weststrate and Deurenberg's formulas. In each age group, we present mean, standard deviation and 5, 25, 50, 75 and 95th percentiles. RESULTS: We present mean, standard deviation and 5, 25, 50, 75 and 95th percentiles of body fat mass (%), in each age group. Body fat mass (%) progressively increased until 10.5 years and, after, progressively decrease at least until 14.5 years. CONCLUSIONS: We present data of body fat mass (%), calculated from the measurement of 4 skinfold thicknesses, obtained from a reference population in the province of Zaragoza. These data are useful as more rationale criteria in the diagnosis of obesity in children and adolescents.

[Fat distribution in children and adolescents of both sexes]. / Distribución de la grasa en niños y adolescentes de ambos sexos.

OBJECTIVE: The aim of this study was to describe anthropometric indexes of fat distribution in 6.0 to 14.9 year old children and to estimate the timing of differentiation of fat patterning in male and female children and adolescents. PATIENTS AND METHODS: We have studied a sample of 1,360 children (701 boys and 659 girls) from Zaragoza, Spain. We have measured triceps and subscapular skinfold thicknessess and waist and hip circumferences. With these measurements, we have calculated the indexes of fat distribution including waist-to-hip circumference ratio and triceps-to-subscapular skinfold thickness ratio. We present the percentiles of these indexes. RESULTS: All percentiles of the waist-to-hip ratio were higher in males than in females. Percentiles 5, 50 and 95 of the triceps-to-subscapular skinfold thickness ratio showed similar values in males and females, except that percentile 95 was higher in males than in females after 10.5 years. CONCLUSIONS: The waist-to-hip ratio seems to define earlier the pattern of fat distribution in children than does the triceps-to-subscapular skinfold thickness ratio. If we take into account the waist-to-hip ratio, the pattern of fat distribution is already present in school age children.

[Differences between morning and afternoon in the assessment of nutritional status by bioelectric impedance in children]. / Diferencias entre la mañana y la tarde en la valoración nutricional del niño mediante impedancia bioeléctrica.

OBJECTIVE: The aim of this study was to examine if there were differences in the assessment of the nutritional status between values of bioelectric impedance (BI) measured in the morning (08:30) and in the afternoon (17:00). PATIENTS AND METHODS: We have studied 30 boys between 6.5 and 10.9 years of age. Weight, stature, skinfold thickness and total body impedance (Z) were measured at 08:30 and at 17:00 on the same day. RESULTS: In 28 of 30 boys, Z at 17:00 was lower than Z at 08:30. The mean decrease in Z was 4.64% of the morning result (p = 0.0001). At 17:00 there was an increase in total body water (TBW) and fat-free mass (FFM) measured by BI, 0.681, and 0.93 Kg, respectively (p = 0.0001), compared with morning values. We did not find differences between skinfold thickness values in the morning and in the afternoon, except for the suprailiac skinfold, which was a bit larger in the afternoon (p = 0.05). In the morning and afternoon there was a high correlation between FFM measured by skinfold thickness and values of TBW and FFM measured by BI. CONCLUSIONS: Z in boys decrease in the afternoon (17:00) compared with morning values (08:30). This fact must be considered by the pediatrician when IB is used for the assessment of nutritional status in children.

[Assessment of the submandibular adipose skinfold for the determination of a nutritional status in children and adolescents]. / Valoración del pliegue adiposo submandibular para la determinación del estado nutricional en la infancia y adolescencia.

OBJECTIVE: The aim of this study was to show the validity of a new skinfold thickness for measuring nutritional status in children. We also compare submandibular skinfold thickness with other anthropometric measures and indices. PATIENTS AND METHODS: We have studied 899 boys and 837 girls between 3.0 and 15.1 years of age. All of them were healthy and from different socioeconomic statuses. We measured weight, height, obesity indices, circumferences, indices of body fat distribution and indices of body fat. Data were divided according to age and sex. We calculated the percentiles of submandibular skinfold thickness and correlations between this parameter and all other measurements were performed. The mean values of the two sexes were compared by using Student's t-test. RESULTS: Submandibular skinfold is an easy and fast skinfold to measure. Its value is maximum at 10 and 11 years in girls and boys, respectively. This measurement is higher in girls than in boys at 5, 7, 10, 13 and 14 years of age (p < 0.05). There was a high correlation between this skinfold value and almost all of the measurements and indices studied, especially with the body mass index (r = 0.589), the sum of the four conventional skinfolds (r = 0.844), arm circumference (r = 0.513), arm fat area (r = 0.776) and percentage body fat (r = 0.830). CONCLUSIONS: Submandibular skinfold thickness in children and adolescents shows a high correlation with body fat indices. It is for this reason that it could be used as a new measurement to assess nutritional status and obesity in children.

[Lipoprotein profile determinants in children and adolescents from a lipid consultation clinic. The impact of diet, body composition and physical activity]. / Determinantes del perfil lipídico en niños y adolescentes asistidos en una consulta de lípidos. Importancia de la dieta, composición corporal y actividad física.

OBJECTIVE: Diet, physical activity, physical fitness and body composition are factors that contribute to lipid disorders; however, we do not know whether they are relevant in children of the general population and in children with dyslipoproteinemias. PATIENTS AND METHODS: We have studied all of these factors in 89 children, aged 4.0 to 20.0 years. Children were divided into two groups: 1) Normocholesterolemics (total cholesterol < 225 mg/dL) and 2) Hypercholesterolemics (total cholesterol > or = 225 mg/dL). RESULTS: In normocholesterolemic children, the main determinants of total and low-density lipoprotein cholesterol were height and cholesterol intake, which explained both 50 and 32% of its variability, respectively. The main determinants of high density lipoprotein cholesterol were blood pressure after submaximal loading and fat mass, which explained 50% of the variability. In hypercholesterolemic children, fat and carbohydrate intake and physical activity explained more than 90% of the variability of total and low density lipoprotein cholesterol. Resting energy expenditure explained 40% of the variability of high density lipoprotein cholesterol. CONCLUSIONS: In the treatment of children and adolescents with dyslipoproteinemias, we must emphasize not only dietary intake, but also physical activity. To increase high density lipoprotein cholesterol we must also improve physical fitness and decrease the amount of body fat mass.

[Bone maturation in obese Aragonese children of both sexes]. / Estudio de la maduración ósea en niños obesos aragoneses de ambos sexos.

OBJECTIVE: To analyze the relation between height and bone maturation in obese children in Aragón. MATERIAL AND METHODS: A group of 86 obese children (36 boys, 50 girls) was studied. Height, weight, cranial circumference, skinfold thickness, Quetelet's index, body fat percentage, total body fat and lean body mass were determined. Bone maturation was calculated according to the three variants of TW2-Aragón method. RESULTS: The patients showed an increase of bone maturation on the three system scores, independently of sex or sexual maturation stage; being the RCC score the most discriminative. Increase of bone maturation was significantly correlated with increase of height (p < 0.001). Regression analysis showed in boys and girls (prepubertal and pubertal) a high statistical significance between bone maturation and anthropometrics parameters estimating body fat (weight, skinfold thickness, total body fat and indices). CONCLUSIONS: The obese children of our study showed an increase of height (p < 0.001) in relation with increase of bone age. Increase of both, bone maturation and height, were significantly correlated with adiposity indices estimating body fat.

[Atherogenic risk factors in children of parents with ischemic heart disease]. / Factores de riesgo aterogénico en hijos de padres con cardiopatía isquémica.

We have studied serum lipid levels and dietetic intake in 38 children whose parents had ischemic heart disease (HPCI) before 55 years of age and in a control group (n = 114). In the HPCI group, 25% had serum levels of total cholesterol higher than 200 mg/dl; only 2 children presented elevated levels of LDL and apo B. Dietetic intakes in both groups were similar, with a high protein (16-17% of calories) and fat (39-42% of calories) intake and a low carbohydrate intake (40.46% of calories). In both groups the percentage of monounsaturated fat was higher than other types of fat. The most frequent phenotype in the HPCI group was IIa (8 children). Only 1 child showed a IIb phenotype. This finding may be due to the variability of this phenotype in the same individual throughout life. In the families (n = 8), we have detected 2 families with polygenic hypercholesterolemia (HP), 2 others with familial combined hyperlipidemia (HFC) and 4 without family history of hyperlipidemia. Taking into account the lipid profile in children of the HPCI group, we have detected the presence of familial dysliproproteinemias. It appears that dietetic intake is not an atherogenic risk factor in these patients.

[Blastocystis hominis and abdominal pain in childhood]. / Blastocystis hominis y dolor abdominal en la infancia.

We report the clinical features observed in 10 children, ranging from 5 1/12 to 13 7/12 years of age, with intestinal infections caused by Blastocystis hominis. A parasitological study of the stools was made by using the ethyl-acetate formol concentration technique and a count of the number of B. hominis per field was performed. In 8 of the cases, no other enteropathogens (viruses, bacteria or other parasites) were found, whereas in 2 cases Giardia lamblia was also isolated. Nine out of ten of the patients presented with abdominal pain. In three of the cases it appeared as a pseudo-appendicular ailment which led to an appendectomy. Those children who were treated with metronidazole and those who were not treated with antibiotic recovered satisfactorily.

[Primary dyslipoproteinemias in a child-adolescent population of Aragón detected by two methods: selective search and targeted search]. / Dislipoproteinemias primarias en una población infanto-juvenil aragonesa detectadas mediante dos estrategias: búsqueda selectiva y búsqueda oportunista.

A series of 439 children (245 boys and 194 girls) ranged between 2.0 and 18.0 years of age have been studied January 1987 to April 1990. They belonged to four groups: I) 306 children (163 boys and 143 girls), "control group"; II) 31 children (22 boys and 9 girls) whose parents had some type of dyslipoproteinemia (HPDLP); III) 38 children (24 boys and 14 girls) whose fathers were survivors of myocardial infarction occurred before 55 years of age (HPCI); and IV) 43 children (23 boys and 20 girls) who had, at least in two occasions, more than three months of time separated between then, over 200 mg/dL of total serum cholesterol levels detected by opportunist search (HDC). For children's identification of risk factors to develop atherosclerotic disease during adult life, two different types of strategy has been utilised. One, "selective search", taking into account children of groups II (HPDLP) and III (HPCI). Other, "opportunist search", taking into consideration children of group IV (HDC). The most frequent primary dyslipoproteinemia between the families of children with high serum levels has been Polygenic Hypercholesterolemia (HP). In the second place were both Familial Hypercholesterolemia (HF) an Familial Combined Hyperlipidemia (HFC). A family with Mixed Hyperlipidemia (HM) was also identified. Familial aggregation, with relation to serum lipid levels, were detected in children of the three groups: HPDLP, HPCI and HDC, as it is reported by another authors. Our results suggest the genetic alterations may contribute to the presence of different types of dyslipoproteinemia in children.

[Hyperapo-beta-emia in children. Study of 17 families]. / Hiperapo-beta-emia en niños. Consideraciones a propósito de 17 familias.

Apolipoprotein (apo)-beta is an atherosclerotic risk factor in adults and children. In families with Familial Combined Hyperlipidemia (FCH) it has been described as a lipoprotein phenotype called Hyperapobetalipoproteinemia (Hyperapo-beta) and characterized by increased numbers of small, dense and apo-beta enriched low density lipoproteins. In our Lipids Clinic, we have studied 267 children, but for the purpose of this paper we have only taken into account the 19 of these children who showed increased plasma total apo-beta levels (Hyperapo-beta-emina). To investigate the type of dyslipoproteinemia of these children, we divided them into two groups: 1) Group 1: 10 children with apo-beta levels greater than mean + 2 standard deviations (SD); 2) Group 2: 9 children with apo-beta levels greater than mean + 3 SD. We have also studied the fathers, mothers, brothers and sisters of all the children. Only one child (Group 1) had type IIb hyperlipoproteinemia. The other children had type IIa hyperlipoproteinemia. In each group, 4 families had FCH and the others had either Familial Hypercholesterolemia or Polygenic Hypercholesterolemia. Families with FCH could also have hyperapo-beta. It is possible that in the future some children of FCH families and those with type IIa hyperlipoproteinemia will have increased plasma triglyceride levels. This could be prevented by a proper diet.